Randomized controlled trial of oral immunotherapy for egg allergy in Japanese patients

Abstract

OIT is effective in increasing the threshold for allergens and inducing desensitization in Japanese egg allergy patients, similarly to North American and European patients.

GRADE-ing the Benefit/Risk Equation in Food Immunotherapy

“…This will impact on both treatment success and safety data: in general, participants who ‘fail’ desensitisation tend to have higher levels of sensitisation and be more prone to treatment-related adverse events (AEs) [ 4 ]. Some studies have chosen to exclude patients with a history of anaphylaxis [ 23 ] or anaphylaxis (with respiratory symptoms) at baseline challenge [ 24 ]. Larger, commercial phase 3 studies may be a more representative of the general food-allergic population; however, they tend to exclude patients who require higher doses of allergen to elicit symptoms.…”

Update on oral immunotherapy for egg allergy

“…In 2016, Akashi et al performed a randomized controlled trial of dry powdered egg OIT in 36 egg-allergic Japanese patients aged 3 to 15 years. 19 Eighteen patients were randomly assigned to the OIT group and 18 to an egg elimination group. Interestingly, OIT was performed at home with dose increases at 3 to 4 day intervals.…”

“…46 Applying this concept, the use of baked egg as OIT product may be a simple and affordable approach to improving the safety of induction of tolerance. The clinical trials in egg OIT completed to date have focused on a variety of egg forms including raw egg, 15,17,23 liquid pasteurized egg, 28 dehydrated egg white 10,13,18,20,[24][25][26]29 , pasteurized egg white 21,27,31 dehydrated whole egg, 16,19 and lyophilized whole egg. 11 In one proof of concept study, the authors developed a 5stage recipe for an egg-containing biscuit to be used in a homebased OIT protocol.…”

“…Notably, several studies have shown that increases in specific IgG4 levels are associated with successful immunotherapy and loss of clinical reactivity to egg. 13,[17][18][19][20]22,26,31,36 Mixed results have been found with regards to egg specific IgE levels, with certain studies showing a significant decrease, 15,17,20,22,[25][26][27]31 and others reporting no significant changes in egg-specific IgE levels during OIT. 16,19,24 Decreases in skin prick test results and basophil activation have also been observed with egg OIT.…”

“…13,[17][18][19][20]22,26,31,36 Mixed results have been found with regards to egg specific IgE levels, with certain studies showing a significant decrease, 15,17,20,22,[25][26][27]31 and others reporting no significant changes in egg-specific IgE levels during OIT. 16,19,24 Decreases in skin prick test results and basophil activation have also been observed with egg OIT. 13,15,17,20,25,27,64 With regards to cellular changes, Perezabad et al 31 have suggested a skewing from a Th2 to T regulatory predominant response following egg OIT.…”